An approach to monitoring influenza vaccination uptake across Europe

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An approach to monitoring influenza vaccination uptake across Europe

Currently, the monitoring of influenza vaccination uptake is mainly a national issue. As influenza infection easily crosses international borders, it is in the interest of all countries to have a high vaccine uptake in people who may be vulnerable when influenza spreads. A Europe-wide monitoring system can provide insight into the strengths and weaknesses of uptake rates in countries and, on ce sufficient levels are achieved, can safeguard the continuation of the achieved levels. This paper aims to address the following issues: a) How is influenza vaccination uptake monitored in Europe? b) What methods to monitor vaccination uptake are available and what are their limitations? c) What steps should be taken to implement a European-wide influenza vaccination uptake monitoring system? Based on existing literature and experiences in monitoring influenza vaccination uptake, an approach to set up a European-wide monitoring system is proposed. The following issues were identified as relevant for influenza vaccination uptake monitoring: a) Agreement on the population groups in which vaccination uptake should be monitored; b) The frequency of data collection; c) The importance of sharing experiences regarding existing influenza vaccination campaigns in order to learn from each other, and develop 'best practices'; d) The need to publish uptake data in close relation with influenza surveillance data and other European efforts on dissemination of vaccination knowledge. To stimulate the discussion on implementing a pan-European influenza uptake monitoring scheme the following recommendations were suggested : a) Develop a common set of variables; b) Build on experience from individual countries; c) Create a coordinating body; d) Create or identify a platform to publish the data; e) Start small and expand rapidly.

Posture and performance: sitting vs. standing for security screening

A classification of the literature on the effects of workplace posture on performance of different mental tasks showed few consistent patterns. A parallel classification of the complementary effect of performance on postural variables gave similar results. Because of a lack of data for signal detection tasks, an experiment was performed using 12 experienced security operators performing an X-ray baggage-screening task with three different workplace arrangements. The current workplace, sitting on a high chair viewing a screen placed on top of the X-ray machine, was compared to a standing workplace and a conventional desk-sitting workplace. No performance effects of workplace posture were found, although the experiment was able to measure performance effects of learning and body part discomfort effects of workplace posture. There are implications for the classification of posture and performance and for the justification of ergonomics improvements based on performance increases.

Pilot scheme for monitoring sickness absence in schools during the 2006/07 winter in England: can these data be used as a proxy for influenza activity?

During influenza epidemics, school-aged children are amongst the first affected patients. They frequently then spread the virus within their families. Recognising influenza activity in schools may therefore be an important indicator of early activity in the wider community. During 2005/06, influenza B was associated with high levels of morbidity in school-children and over 600 schools outbreaks were reported to the Health Protection Agency by local Health Protection Units. While it is not possible to directly monitor influenza in schools, the feasibility and validity of using sentinel school absenteeism data, as a proxy for influenza in the community can be investigated. From week 02/07 to 20/07, eight primary and three secondary schools from five HPA regions were able, via the Department of Health-funded Health Protection Informatics website, to report daily electronic registration data, relating to absenteeism due to illness. Aggregated absenteeism data due to illness peaked the same week as indices for the age group comparable to that used by the Royal College for General Practitioners and NHS Direct schemes. When illness-defined absenteeism data was stratified into primary and secondary schools, absence in primary schools peaked one week before that in secondary schools and the established schemes for all ages. The start time of the study meant that initial increases in activity could not be measured. These encouraging results justify expanding this sentinel scheme to collect more rigorous evidence of the usefulness of absenteeism as a proxy for influenza activity and a tool to inform policy and trigger local responses.

Patient satisfaction and quality of life among persons attending chronic disease clinics in South Trinidad, West Indies

OBJECTIVE

Patient satisfaction and quality of life are increasingly being recognized as central elements in the monitoring and evaluation of healthcare. In this survey, the level of patient satisfaction and quality of life were investigated in regular attendees at public health chronic disease facilities in South Trinidad.

METHOD

A random sample of 200 clients attending the three public chronic disease clinics during the period August 12, 2002 to December 31, 2002, completed self-administered questionnaires consisting of socio-demographic, quality of life (SF 12) and health service items.

RESULTS

Participants had an average of four annual visits and 75% of them were 50 years and older. Approximately two-thirds of participants gave health and support staff a rating of good to excellent. Overall clinic experience was rated as poor to fair by 41.5%. Forty-five and a half per cent gave a rating of the explanations given by doctors and nurses about their illnesses. Fifty-three and a half per cent and 58% gave a poor to fair rating for the length of the waiting time and explanation offered when there was a significant delay in the starting times of clinics respectively. In regression analyses controlling for age, gender and number of illnesses, ratings of clinic experience and all categories of clinic staff were significantly associated with SF-12 mental and physical component summary scores.

CONCLUSION

The findings suggest that in this population of regular clinic attendees, levels of client satisfaction and numbers of illnesses are associated with subjective quality of life.

Managing Legionnaires' disease in Europe: the need for international collaboration

Travel and tourism is an increasingly important economic activity throughout Europe and the rest of the world.

Outbreak of respiratory infection on a cruise ship

On 27 July 2007, the Department of Communicable Disease Control and Prevention of Stockholm County Council (SCC), Sweden, was informed by one of the infectious diseases hospitals in Stockholm that three elderly women travelling on a cruise ship had been hospitalised due to severe pneumonia

Ethnic neutropenia among women of European, African, and Caribbean backgrounds

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Background: Black women are less likely than white women to receive complete chemotherapy for cancer. One reason for interruption of chemotherapy may be a patient's low white blood count (WBC) or absolute neutrophil count (ANC). In studies of white blood cell count (WBC) and race, white individuals’ WBC has been considered the standard, and 25–40% of non-Hispanic black individuals have been described as having “benign ethnic neutropenia.”. We therefore studied the prevalence and severity of ethnic neutropenia among women in six ethnic groups and of the association between neutropenia and serum cytokine and C-reactive protein (CRP) levels and neutrophil elastase (ELA2) polymorphisms. Methods: Following IRB approval, each participant provided a blood sample that was tested for WBC with differentials, cytokines and CRP levels, and ELA2 polymorphisms. We compared median WBC and ANC using Kruskal-Wallis tests. We used Fisher's exact tests to analyze association of severe neutropenia with ethnicity, cytokine and CRP levels, and ELA2 polymorphisms. Results: We enrolled 263 women 20–70 years old who had no cancer diagnosis.. As the table shows, median WBC and ANC differed by group; Dominicans had significantly higher median WBCs and ANCs than all other groups. Of 12 women with severe neutropenia (ANC = 1,500), none was Dominican or European-American. Subjects with a common upregulating ELA2 promoter polymorphism (C-199A) had lower ANC counts than other subjects. No associations were found between ANC counts and either cytokines or CRP levels. Conclusions: Median WBC and ANC and severe neutropenia were associated with ethnicity. Mild neutropenia is considered clinically benign, but because severe neutropenia may result in decreased doses or delays in chemotherapeutic treatment for malignancies, ethnic neutropenia and its role in treatment decisions requires further investigation.

No significant financial relationships to disclose.

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Outbreaks of influenza and influenza-like illness in schools in England and Wales, 2005/06

In England and Wales, clinical reports from primary care showed that influenza activity for the season 2005/06 only rose above the base line for four weeks during February 2006. However, outbreaks of influenza-like illness and/or gastrointestinal infection in schools began to be reported to the Health Protection Agency, Centre for Infections in early January 2006. To quantify the type, size and the spread of these outbreaks a reporting form was distributed to local Health Protection Units in England and to Wales for retrospective and prospective weekly completion. Between weeks 48/05 and 11/06, a total of 688 school outbreaks were reported, including 658 outbreaks of influenza-like illness with or without other symptoms. The remaining 30 outbreaks listed as gastrointestinal only were excluded from the present analysis. Influenza B was confirmed in 70 outbreaks where testing took place. 61% of the outbreaks were reported from primary schools for children aged 4-11 years. This large scale outbreak in school children with flu-like illness across England and Wales was not picked up by most of the routine surveillance schemes, therefore, we believe that a school absentee monitoring and reporting system may be needed to give an early warning of increased influenza activity, especially for the mild form of the disease caused by influenza B virus.

Linking syndromic surveillance with virological self-sampling

Calls to a UK national telephone health helpline (NHS Direct) have been used for syndromic surveillance, aiming to provide early warning of rises in community morbidity. We investigated whether self-sampling by NHS Direct callers could provide viable samples for influenza culture. We recruited 294 NHS Direct callers and sent them self-sampling kits. Callers were asked to take a swab from each nostril and post them to the laboratory. Forty-two per cent of the samples were returned, 16.2% were positive on PCR for influenza (16 influenza A(H3N2), three influenza A (H1N1), four influenza B) and eight for RSV (5.6%). The mean time between the NHS Direct call and laboratory analysis was 7.4 days. These samples provided amongst the earliest influenza reports of the season, detected multiple influenza strains, and augmented a national syndromic surveillance system. Self-sampling is a feasible method of enhancing community-based surveillance programmes for detection of influenza.

Legionnaires' disease outbreak associated with a cruise liner, August 2003: epidemiological and microbiological findings

Eight cases of Legionnaires' disease were identified among the 215 German passengers after a cruise to the Nordic Sea in August 2003. An unmatched case-control study was conducted to identify risk factors and the source of infection. In total, eight passengers fulfilled the case definition, one of these died. Forty-two passengers served as controls. The attack rate was 4%. The mean age was 60 years for cases and 62 years for controls. Prolonged exposure to the spa pool seemed to be a risk factor of infection (OR 4.85, P=0.09). Legionella pneumophila serogroup 1, monoclonal antibody (mAb) subgroup 'Knoxville' was isolated from clinical and environmental samples. DNA sequence-based typing revealed that these isolates were indistinguishable from each other. The investigation showed the importance of an interdisciplinary approach of microbiology and epidemiology as not all sites on the ship that tested positive for L. pneumophila actually posed a relevant risk for the passengers.

Legionnaires' disease in Europe 2003-2004

Once a year, countries that collaborate in the European Surveillance Scheme for Travel Associated Legionnaires’ Disease (EWGLINET) are requested to submit a dataset that provides epidemiological and microbiological information on cases of legionnaires’ disease (nosocomial (hospital-acquired), community and travel related) detected in their country for that year. This paper presents the data collected for 2003 and 2004. For this period, 9166 cases were reported to the dataset by 35 countries, of which 941 cases were associated with outbreaks. Fourteen countries reported a total of 218 detected outbreaks. National infection rates varied between countries from 28.7 to less than one case per million population. This information is valuable in that it allows countries to assess the effectiveness of their national surveillance schemes in detecting cases. Over the two year period, 748 cases were reported to have died, giving a case fatality rate of 8.2%. The lack of detailed epidemiological information on deaths from legionnaires’ disease is highlighted. The establishment of the European Centre for Disease Prevention and Control is seen as an opportunity to develop European collaborations more fully, and to increase further the protection of Europeans from outbreaks of legionnaires’ disease.

Approche des transferts de pollution bactérienne dans une crue karstique par l'étude des paramètres physico-chimiques

L'exploitation des systèmes aquifères karstiques est toujours effectuée sous des contraintes liées à leur forte vulnérabilité. Une étude complète d'un épisode de crue de la source du Lez a été réalisée grâce à une coopération entre les Services de Santé et l'Université. Cette étude comporte une observation des paramètres physico-chimiques et bactériologiques sur une période de 15 jours, correspondant à une réponse hydrodynamique impulsionnelle sur la totalité du bassin. Les pas de temps d'échantillonnage varient de 4 à 24 heures.

L'interprétation des résultats physico-chimiques met en évidence une disjonction nette entre les variations piézométriques et le passage de différents volumes d'eau. L'écoulement des eaux plus chaudes (16,5 °C) observé lors de l'étiage, eaux d'origine profonde plus chargées chimiquement se poursuit jusque vers le milieu de la décrue pour faire place à l'arrivée d'eaux plus froides correspondant à des infiltrations rapides puis retardées. Les eaux les plus chaudes sont caractérisées par des variations des teneurs en magnésium, les teneurs en calcium restant à peu prés constantes. Inversement; les eaux froides de l'infiltration retardée ont de faibles variations des teneurs en magnésium et sont tracées par une forte augmentation des valeurs en calcium.

Le risque sanitaire maximal est lié au début de l'arrivée des eaux froides. Les eaux d'étiage et les eaux profondes sont légèrement contaminées. Les eaux d'infiltration retardée sont peu contaminées. En dehors des zones de perte du réseau hydrographique et des axes d'infiltration rapide, la vulnérabilité de l'aquifère est faible à l'échelle du bassin.

Lack of association between androgen receptor polymorphisms and bone mineral density or physical function in older men

Individuals whose androgen receptors have short polyglutamine tracts (resulting from CAG repeats) may have greater receptor signaling activity of the androgen receptor. We evaluated the association between bone mineral density (BMD) and CAG repeats in 91 older men with normal (control) and low femoral neck (EN) BMD (OP) or a history of femoral fracture (FX). Bioavailable testosterone (BioT) and physical performance, including composite score (EPESE) and physical activity (PASE), were also measured. Comparing FX, OP, and control subjects, we observed BMD Tscores of -2.16 +/- 1.08, -2.26 +/- 0.74, and -0.20 +/- 0.40 (p < 0.001); CAG repeat lengths of 21.9 +/- 2.7, 22.5 +/- 2.4, and 22.3 +/- 2.9 (p = 0.63); BioT levels of 2.29 +/- 1.25, 2.19 +/- 1.11, and 3.99 +/- 1.25 nmol/L (p < 0.001); EPESE scores of 8.0 +/- 3.0, 9.7 +/- 2.0, and 11.3 +/- 0.9 (p < 0.001); and PASE scores of 91 +/- 66, 122 +/- 66, and 200 +/- 55 (p < 0.001), respectively. There were no significant correlations between CAG repeats and BioT or physical performance. Men with osteoporosis or fracture had lower BioT, physical performance, and physical activity than controls. This study found no association between CA G repeats and FN BMD in older men with normal or low BMD or FX.

Optical Characterization of Eu3+Ions in CdSe Nanocrystal Containing Silica Glass

Silica glass samples containing CdSe/Eu3+ ions were prepared by sol-gel route. Size distribution and optical band gap of the nanoparticles were calculated from absorption spectrum. It is observed that the presence of CdSe nanocrystallites enhances the fluorescence of europium in silica glass. The phonon sideband spectrum associated with the excitation transition 7F0-5D2 is used to analyze the electron-phonon coupling and nonradiative deexcitiation of the rare earth ions in the glass host, The observed fluorescence enhancement is discussed on the basis of phonon assisted energy transfer from electron-hole recombination of the CdSe nanocrystallites to the rare earth ion and multiphonon relaxation.

Travel Associated Legionnaires' Disease in Europe : 2003

Six hundred and thirty two cases of travel-associated legionnaires' disease with onset in 2003 were reported to the EWGLINET surveillance scheme by 24 countries. Eighty nine clusters were detected, 35 (39%) of which would not have been detected without the EWGLINET scheme. One hundred and seven accommodation sites were investigated and 22 sites were published on the EWGLI website. The proportion of cases diagnosed primarily by the urinary antigen test was 81.2%, and 48 positive cultures were obtained. Thirty eight deaths were reported to the EWGLINET scheme, giving a crude fatality rate of 6%. Countries are encouraged to inform the coordinating centre of cases that fall ill after travelling within their own country of residence ('internal travel'), and are also encouraged to obtain patient isolates for culture where at all possible.

Travel associated legionnaires' disease in Europe: 2003

Six hundred and thirty two cases of travel-associated legionnaires' disease with onset in 2003 were reported to the EWGLINET surveillance scheme by 24 countries. Eighty nine clusters were detected, 35 (39%) of which would not have been detected without the EWGLINET scheme. One hundred and seven accommodation sites were investigated and 22 sites were published on the EWGLI website. The proportion of cases diagnosed primarily by the urinary antigen test was 81.2%, and 48 positive cultures were obtained. Thirty eight deaths were reported to the EWGLINET scheme, giving a crude fatality rate of 6%. Countries are encouraged to inform the coordinating centre of cases that fall ill after travelling within their own country of residence ('internal travel'), and are also encouraged to obtain patient isolates for culture where at all possible.

Community-acquired Legionnaires' disease in Nottingham--too many cases?

The aim of this study was to compare the incidence of community-acquired Legionnaires' Disease in Nottingham with England and Wales and to explore reasons for any difference observed. Based on data from the National Surveillance Scheme for Legionnaires' Disease (1980-1999), the rate of infection in England and Wales was 1.3 per million/year compared with 6.6 per million/ year in Nottingham. Domestic water samples were obtained from 41 (95%) of 43 Nottingham cases between 1997 and 2000. In 16 (39%) cases, Legionella sp. were cultured in significant quantities. Proximity to a cooling tower was examined using a 1:4 case-controlled analysis. No significant difference in the mean distance between place of residence to the nearest cooling tower was noted (cases 2.7 km vs. controls 2.3 km; P = 0.5). These data suggest that Nottingham does have a higher rate of legionella infection compared to national figures and that home water systems are a source.

European Surveillance of Travel Associated Legionnaires' Disease

Disease acquired in one country but diagnosed and reported in another, necessitates international cooperation if it is to be controlled, investigated and further cases prevented. The European surveillance scheme for travel associated legionnaires' disease (EWGLINET) was established in 1987 to operate in this type of context and has been highly active in sharing information and coordinating its actions since then. In July 2002 European guidelines were introduced by EWGLINET that have standardised the response to clusters across most countries in Europe. Three papers presented in this special issue show how the guidelines have been successfully adopted in France (1), Italy (1) and Spain (2), despite the additional workload associated with their implementation. The paper from the coordinating centre in London provides an overview of EWGLINET results in 2002.

Travel associated legionnaires' disease in Europe: 2002

Twenty countries reported 676 cases of travel associated legionnaires' disease to the EWGLINET surveillance scheme, and 94 clusters were detected. 80.5% of all cases were diagnosed by the urinary antigen test. On average there were 20.5 days between onset and report of cases, compared with 51.5 days in 1993. Between the introduction of the EWGLI investigation guidelines (on 1st July 2002) and the end of 2002, 37 six-week investigation reports were accepted as satisfactory and on time by the coordinating centre. 274 sites were investigated in total in 2002. The travel patterns of the main reporters in EWGLINET influenced the months of peak activity, and helped to determine which countries bore the greatest investigation burden.

Travel associated legionnaires' disease in Europe: 2002

Twenty countries reported 676 cases of travel associated legionnaires' disease to the EWGLINET surveillance scheme, and 94 clusters were detected. 80.5% of all cases were diagnosed by the urinary antigen test. On average there were 20.5 days between onset and report of cases, compared with 51.5 days in 1993. Between the introduction of the EWGLI investigation guidelines (on 1st July 2002) and the end of 2002, 37 six-week investigation reports were accepted as satisfactory and on time by the coordinating centre. 274 sites were investigated in total in 2002. The travel patterns of the main reporters in EWGLINET influenced the months of peak activity, and helped to determine which countries bore the greatest investigation burden.